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Objective of our study is qualitative and quantitative comparison of contrast enhanced ultrasound (CEUS) and F-18-FDG-PET-CT examination in the follow-up of hepatic alveolar echinococcosis (HAE). Parasitic lesions are to be examined regarding number, size, morphology, calcification, vascularization (CEUS) and metabolic activity (F-18-FDG-PET-CT). We aim to answer the question whether delineation and measurement of liver lesions in HAE can be improved by ASQ and we want to explore how ASQ parameters in HAE lesions develop. 36 patients with proven, medically-treated HAE have been included in this study. Abdominal ultrasound, ASQ and CEUS have been carried out. As part of the monitoring, patients were examined by F-18 FDG PET-CT. F-18-FDG uptake in parasitic lesions has been diagnosed by F-18-FDG-PET-CT in 32 of 36 patients. Vascularization of liver lesions has been detected by CEUS in 22 of 32 FDG-positive patients with sensitivity of 69 % and specificity of 100 %. Mean maximum diameter of the lesions was 69.5 mm in CEUS and 63.7mm in B-scan ultrasound. Parasitic tumors appearvmore prominent in color-coded ASQ imaging, but size of lesions measured in ASQ mode does not differ from size
measurements in B-mode. Statistical comparison of ASQ parameters shows significant results. Compared with F-18 FDG PET-CT as a gold standard in determining metabolic activities of liver lesions in HAE, CEUS represents vascularization of active lesions with high specificity and sensitivity. The dimensions of parasitic lesions are displayed more precisely through CEUS than in B-scan. ASQ is a promising sonographic method for examination and quantification of structural changes of liver parenchyma in HAE lesions.